DEBRA RUZENSKY: All of our cells need fuel to survive. They usually rely on glucose, a simple form of sugar. Like gas-guzzling cars that need extra fuel, rapidly dividing cancer cells consume more glucose than other cell types. It’s tempting to think that we can keep cancer cells from growing by avoiding sugar or carbohydrates. That’s not entirely accurate.

When we eat sweets, fruits, whole grains or other carbohydrate-rich food, the result of our digestion is an increase in blood glucose levels. If you eliminate sugar from your diet by fasting or eating a diet low in carbohydrates, your body still needs energy. To meet that need, your body will begin making its own sugar, also causing an increase in blood glucose levels.

To produce its own sugar, the body breaks down fat and then protein, which can be desirable for people who need to lose weight. We may not want that to happen in patients undergoing cancer treatment, however, because some patients struggle to maintain their weight. Patients being treated also can experience muscle loss, which makes recovery more difficult. If the body is forced to break down muscle for fu​el, that can make the situation even worse.

Of course, this doesn’t mean you should eat a lot of sugary foods. Many foods and beverages that are high in sugar provide little to no nutritional value. Sugar in the diet is also associated with weight gain and increased production of the hormones insulin and insulin-like growth factor, which are all linked to cancer. Instead, focus on eating complex, whole foods without added sugars. Examples include whole grains, fruits, starchy vegetables, nuts and seeds. If you are going to have a sweet treat, have it along with a meal so the sugars will be mixed in your stomach with protein, fat and fiber.

While you need not avoid all sugar, concentrate on fueling your body with the most nutritious food you can. A balanced diet can help support the immune system and give you the energy and strength you need to carry you through this difficult time.

Jamie Schwachter, Advanced Practice Nurse for the Cleveland Clinic Taussig Cancer Institute and co-author​ of The Complete Cancer Organizer: Your Answers to Questions About Living With CancerPhoto courtesy of the Cleveland Clinic

JAMIE SCHWACHTER: The first thing to think about is your relationship with your friend. How close are you? Did your friend tell you about his diagnosis, or did you learn about it from someone else? If your friend hasn’t mentioned his cancer to you, it may be a sign that he doesn’t want to talk.

If the subject does come up, you might feel like you don’t know how to act or what to say, and your friend may feel the same. I recommend that you be frank. Ask him whether he would like to talk about his cancer. He may say no, but at least he’ll know the door is open. If your friend doesn’t want to talk about his cancer or becomes tired of talking about it, respect his wishes. He might decide to talk about it later, and he’ll know you’re there for him.

In these conversations, it’s important to follow what I call good cancer etiquette. There are things you should avoid saying to your friend. For example, don’t tell him y​ou know what he is going through. Everyone reacts to a cancer diagnosis and treatment differently, and you don’t really know what your friend is going through even if you’ve had cancer yourself. Don’t say “you don’t look like you have cancer” or “things happen for a reason.” Sometimes, people find themselves at a loss for words and these things come out. But statements like these negate your friend’s feelings.

The most important thing you can do for your friend is to listen actively. Remain focused on him and avoid making comparisons to other people and their experiences with cancer. Take your time and maintain good eye contact. It’s OK to show emotion, as long as you don’t make it about you.

Sometimes, talking may be too difficult for your friend. In that case, consider sending a card, an email or a thoughtful text message now and then to let him know you are thinking about him. And remember, every conversation doesn’t have to be about cancer. Sometimes the best thing you can do for a friend is to catch a funny movie and laugh together. No talking required.

Katherine DuHamel, Health Psychologist at Memorial Sloan Kettering Cancer Center in New York City
Photo courtesy of Memorial Sloan Kettering

KATHERINE DUHAMEL: Feelings of anxiety can be intense as the date of a scan approaches. We even have a special name for it: scanxiety. It’s now recognized that, just like any other cue or trigger, scans in patients who have experienced a life-threatening illness like cancer can lead in the most extreme cases to flashbacks and other symptoms of post-traumatic stress disorder. If you are feeling anxiety, it can be reassuring to know that what you are experiencing is a conditioned reaction that is not uncommon.

The number one way to help with anxiety is just to breathe. Find a good relaxation, mindfulness, self-hypnosis or meditation exercise that works for you. That’s the physical part.

Next, consider the way that you talk to yourself. Sometimes your internal dialogue can be unhelpful. You might be telling yourself things like “I can’t stand it” or “I can’t go through treatment again.” It’s useful to evaluate these thoughts and to come up with more helpful alternatives. For example, tell yourself that if the cancer comes back, you’ll be able to cope. Remind yourself that you are in good hands. Simply repeating to yourself “I think I can, I think I can” sometimes helps.

I ask my patients to generate their own helpful thoughts and write them down or put them on their smartphones. Boil them down to a quick sound bite—something you can repeat easily and quickly to yourself when you get anxious. Make sure the thoughts become so familiar that you can recall them readily.

In some cases, anti-anxiety medication in combination with these strategies is helpful. Social support is also key. Find a friend, spouse or other loved one who can coach you. Perhaps you can practice meditation or relaxation training together. Seek out a therapist you can talk to, a good support group, or both, either in person or online. And remember, you can get through this.